It has often been said that it is not possible to inspect quality into care, and that many of the best innovations in care have come from local, ground floor initiatives rather from top down regulation.  Moreover, Francis and Kirkup, among others, have recognised inflated and overly complex regulations stand as barriers to good care.

The Essential standards, from the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009, encompassed pretty much every piece of guidance and legislation underpinning all aspects of health and social care.  

When the Trust I worked for was inspected under the new inspection regime but still under the Essential Standards, much energy was focused on translating the care standards for ward staff.  Given that the eventual report result was “Requires Improvement”, I question if we were particularly successful.

With the problems uncovered at Mid Staffs, and the pleas for greater transparency and clarity in the subsequent Francis Report, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 ushered in the Fundamental Standards.  These are the minimum standards of care that patients and their families should expect from health care providers.

It is important that clinical areas are clean, that our patients don’t suffer neglect under our care; and we can recognise that something went wrong when water has to be prescribed.  I am hopeful that the sentiment behind Francis, and subsequently Winterbourne View & Morecambe Bay reports result in higher quality and safer care.  I am not convinced, however, that the CQC are the best organisation to achieve this.

By simplifying healthcare standards down to their fundamentals, I fear that for some providers, these will become ceilings of care rather than a very minimal bar.  I am also concerned that providers may have missed  that they now responsible for independently assuring themselves that they meet all of the legislative requirements that the Fundamental Standards no longer cover.

In preparation for our last comprehensive inspection, we went to all of the clinical areas within the Trust.  We discussed with staff what they could expect, and for a change, asked staff what they needed.  They clearly told us that they needed more colleagues, and that the equipment they were dependant on was too scarce.  The inspection was expensive for the Trust – additional staff, annual leave denied over the four days of the inspection and a dedicated team working from early in the morning till very late at night.  It must have been even more expensive for the CQC – 50 inspectors, data analysts, experts by experience and clerical staff, hotels, transport – the logistics must have been dizzying.  The final report was published, essentially telling us that the Trust was short-staffed and could use some additional equipment.

The CQC are publishing a further overview of their performance in April 2016.  With the CQC losing 40% of their budget, I suspect that there will be some scaling back of inspections – that all health care providers will be granted a baseline inspection, and then will undergo formal, comprehensive inspections if they become data/paper outliers.  I also suspect that Intelligent Monitoring (once published quarterly, now defunct) will become much more important as a guide.  This means that provider data will need to be much more accurate – giving providers an opportunity to utilise the data as knowledge.

For all you regulation geeks, these are exciting times!!